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VIII. MISCELLANEOUS INFORMATION:

1. If You have any pecuniary interest in or own any stock or bonds of and civil aeronautics enterprise, give the name of the institution(s) none

2. If you are related by blood or marriage to anyone in the employ of the U.S. Government or of the government of the District of Columbia, fill out the form below: none

[[3 column table]]
| Relationship | State Name And Address | Agency In Which Employed |
[[No input]]

Legal Voting Residence

State and Congressional: District New York
County: Bronx
City: New York

4. If you now hold any elective or appointive Federal, State, or municipal office, give details no

5. If you have had military or naval (reserve or service), indicate:
(a) Branch of service none
(b) Highest Rank Attained [[blank]]
(c) Date Enlisted [[blank]]
(d) Date discharged [[blank]]

6. Have you established military preference with the U.S. Civil Service Commission?
Yes [[blank]]
No no

7. If so, check preference below:
5-point [[blank]]
Disability [[blank]]
Wife of Disabled veteran [[blank]]
Widow of veteran [[blank]]

8. If you receive any pension or other benefit (exclusive of Adjusted Service Certificate) for military or naval service, give details none

9. If you receive annuity from the U.S. Government under the Retirement Act, describe its nature and amount none

10. To what extent do you use intoxicants? Moderayely [Moderately]

11. Are there any unsatisfied judgements on record against you? none

If so, state amount, nature of judgement, name of creditor, and reason for nonpayment* [[blank]]

12. Have you ever had a surety bond canceled or any application denied by a bonding company?
no 

If so, state particulars* [[blank]]

13. State amount of your unsecured outstanding obligations none

14. If you have been arrested, indicted, or convicted for a violation of law other than a minor traffic violation, or finally adjudged liable in damages in any civil proceedings for fraud, state name of court, nature and disposition of the case no

15. Have you ever been discharged or required to resign from any position? no

If so, state the name of the organization and reason [[blank]]

16. If you have any income or concurrent connection in addition to your regular salary, state the amount per year and the source** none

17. Do you own your home? [[blank]]

Rent house? [[blank]]

Rent Apartment? yes

Board? [[blank]]

18. Do you own real estate? no

Value, $[[blank]]

Incumbrance, $[[blank]]

19. Do you own stocks, bonds or securities? yes
Value, $1000
Incumbrance, $[[blank]]

20. How much life insurance do you carry? none

21. Have you ever been refused life insurance? no

Why? [[blank]]

I certify that the foregoing answers are correct to the best of my knowledge and belief. (Applications are thoroughly investigated. Any false statement is sufficient cause for rejection or dismissal after appointment.)

[[signature line]]
(Signature of applicant)

*If necessary, attach a detailed statement concerning any items that require amplifications
**Questions 16-21 are considered desirable in determining stability but may be omitted if applicant is reluctant to furnish information.

(4)                    U.S. GOVERNMENT PRINTING OFFICE 16–8177